FAYETTEVILLE, N.C. – A year after Americans recoiled at new revelations that sick veterans were getting sicker while languishing on waiting lists — and months after the Department of Veterans Affairs launched major reforms — government records show the number of patients facing long waits at VA facilities hasn't dropped.

No one expected the VA mess could be fixed overnight. But the Associated Press has found that since the summer, the number of medical appointments delayed 30 to 90 days has largely stayed flat. The number of appointments that take longer than 90 days to complete has nearly doubled.

Nearly 894,000 appointments completed at VA medical facilities from Aug. 1, 2014, to Feb. 28 failed to meet the health system's timeliness goal, which calls for patients to be seen within 30 days.

That means about 1 in 36 patient visits involved a delay of at least a month. Nearly 232,000 of those appointments involved a delay of longer than 60 days.

Waits vary by area

A closer look reveals deep geographic disparities.

Many delay-prone facilities are clustered in a handful of Southern states, often in areas with a strong military presence, a rural population and patient growth that has outpaced the VA's sluggish planning process.

Of the 75 clinics and hospitals with the highest percentage of patients waiting more than 30 days for care, 12 are in Tennessee or Kentucky, 11 are in eastern North Carolina and the Hampton Roads area of Virginia, 11 are in Georgia or southern Alabama, and six are in north Florida.

Seven more were clustered in the region between Albuquerque, New Mexico and Colorado.

Those 47 clinics and hospitals represent a fraction of the more than 1,000 VA facilities nationwide, but they were responsible for more than 1 in 5 of the appointments that took longer than 60 days to complete.

Caught in the shuffle

That has meant big headaches for veterans like Rosie Noel, a retired Marine sergeant awarded the Purple Heart in Iraq after rocket shrapnel slashed open her cheek and broke her jaw.

Noel, 47, said it took 10 months for the VA to successfully schedule her for a follow-up exam and biopsy after an abnormal cervical cancer screening test. Her first scheduled appointment in February of 2014 was postponed because of a medical provider's family emergency, she said.

Her make-up appointment at the VA hospital in Fayetteville, one of the most backed-up facilities in the country, was canceled when she was nearly two hours into the drive from her home in Sneads Ferry on the coast.

Noel said she was so enraged, she warned the caller she had post-traumatic stress disorder — and they better have security meet her in the lobby.

"To say I was livid is being mild," she said.

Mixed results

The AP examined waiting times at 940 facilities to gauge changes since a scandal over delays led to the resignation of the VA's secretary and prompted lawmakers to give the agency another $16.3 billion to hire doctors, open more clinics and create the Choice program. The new program allows patients facing long delays to get care from a private-sector doctor. Records for individual facilities were not available for August.

The analysis reveals stark differences between the haves and have-nots.

In the Northeast, Midwest and Pacific Coast states, few VA sites reported having significant delays. A little less than half of all VA hospitals and clinics reported averaging fewer than two appointments per month that involved a wait of more than 60 days.

But at the VA's outpatient clinic in Jacksonville, Florida, 7,117 appointments completed between Sept. 1, 2014, and Feb. 28 involved a wait of more than 60 days.

VA officials cite numerous efforts to ramp up capacity by building health centers and hiring more staff. In Fayetteville, the VA is finishing a new 250,000-square-foot health center to help alleviate the delays that frustrated Rosie Noel.

They also say that in one statistical category, the VA has improved: The number of appointments handled by VA facilities between May 2014 and February was up 4.5 percent compared with the same period a year earlier. Referrals to private sector doctors are rising.

Increasing demand

But officials also acknowledge that in some places, the agency is perpetually behind rising demand. Enrollees in the VA system have ballooned from 6.8 million in 2002 to 8.9 million in 2013.

"I think what we are seeing is that as we improve access, more veterans are coming," Deputy Secretary of Veterans Affairs Sloan Gibson said.

He also acknowledged the VA has taken too long to plan and build new clinics and hasn't been flexible about reallocating resources to areas experiencing fast growth.

"We are doing a whole series of things — the right things, I believe — to deal with the immediate issue," Gibson said. "But we need an intermediate term plan that moves us ahead a quantum leap, so that we don't continue over the next three or four years just trying to stay up. We've got to get ahead of demand."

He also asked for patience ramping up the Choice program. Between Nov. 5, 2014, and March 17, about 46,000 patients had made appointments for private-sector care through the new option — a drop in the bucket for a system averaging 4.7 million appointments per month.

WHERE VETS WAIT LONGEST FOR CARE

The Veterans Affairs system operates more than 1,000 facilities. Here is a look at some regions where waits were longest over a six-month period from Sept. 1, 2014, to Feb. 28:

Northern Florida

The VA outpatient clinics in Jacksonville, Tallahassee, Panama City and Pensacola collectively completed 250,000 appointments during the six-month period. Nearly 13 percent of those visits involved a wait of longer than 30 days, well above the national average of 2.8 percent. In Jacksonville, 7,117 appointments involved a wait of more than 60 days.

Central Alabama

From September to February, the veterans hospital in Tuskegee, Alabama, and its sister medical center in nearby Montgomery struggled more than any other VA hospitals to meet the department's goals for timely access to care. About 9 percent of patient visits involved a wait of longer than 30 days.

Georgia

Of the 100 VA hospitals and clinics with the most patients waiting more than 30 days for care, 10 are in Georgia. A small VA clinic near Fort Benning, in Columbus, Georgia, has been among the worst performers. About 13 percent patient visits involved a wait of more than 30 days. It has close to the longest average wait for mental health care in the country. At the VA hospital in Dublin, one in 36 appointments involved a wait longer than 60 days.

Eastern North Carolina

North Carolina is home to the Army's Fort Bragg, the Marines' Camp Lejeune, and nine of the 50 VA medical facilities with the most patients waiting more than 30 days for care. About 16 percent of the vets getting treatment at the clinic in Jacksonville, North Carolina, had to wait longer than 30 days for an appointment. Nearly 1 in 9 patients there had to wait longer than 60 days to see a caregiver. The VA has opened several new clinics in the state in recent years to deal with long waits, but those new and expanded sites haven't met expanding demand.

Hampton Roads, Virginia

About 7.3 percent of the appointments completed at the VA hospital in Hampton Roads failed to meet the department's timeliness standards. At the outpatient clinic in Virginia Beach, 18 percent of patient visits involved a wait of longer than 30 days — although things have been improving. The clinic completed nearly 89 percent of its visits in a timely fashion in February, compared with 76 percent six months earlier.

Tennessee and Kentucky

Thirteen of the 100 VA sites with the highest percentage of patients waiting more than 30 days are in Kentucky and Tennessee. The outpatient clinic in Hopkinsville, Kentucky, has the highest percentage of delayed appointments of any VA clinic in the country. Nearly 20 percent of the 5,377 appointments completed at that facility involved a wait of longer than 30 days, and things have been getting steadily worse since the summer.

HOW THE ANALYSIS WAS DONE

Everyone agrees on the problem: Many patients at Veterans Affairs hospitals and clinics are waiting too long to see the doctor. But what's the best way to measure that problem?

•In setting out to evaluate the performance of 940 hospitals and clinics in the VA system, the Associated Press chose to focus on the number of appointments that failed to meet the VA's own timeliness goal, which calls for patients to receive non-emergency care within 30 days.

•In some ways, that number — 30 days — is arbitrary. A one-month wait for a routine annual physical is hardly a burden. For someone in physical or mental pain, 30 days could be an eternity.

•The standard, though, is a significant one in the VA bureaucracy. Under a law passed in August, VA patients who have to wait longer than 30 days for an appointment are supposed to be offered a chance to switch to a private-sector doctor, at the VA's expense.

•And, despite its clinical insignificance, the 30-day standard is a useful barometer for identifying VA sites that have a problem providing timely care.

•Ideally, any analysis of patient waits at the VA would include a look back of at least a year, if not much longer, but here that was not possible.

•The VA has made some adjustments in the way it calculates its statistics on delays, including doing away with a system of measuring delays from the time an appointment is entered into the VA's scheduling software, rather than from the date when the patient actually wanted or needed to receive care.

•Those changes, made in late summer, had the effect of roughly halving the number of appointments that failed to meet the VA's 30-day timeliness standard and radically changing the average wait times reported by facilities. For that reason, the data the VA releases now can't be compared directly with numbers it generated in the spring.

•The AP analysis includes a look at system-wide VA data from Aug. 1, 2014, to Feb. 28, and statistics on individual VA facilities from Sept. 1, 2014, to Feb. 28. A detailed breakdown of facility performance in August wasn't available.